Saturday, June 18, 2016

Video: The Gory Details of ABIM Maintenance of Certification

The Pennsylvania Medical Society posted the presentations made at the AMA House of Delegates Meeting at the Hyatt Regency Chicago on 13 Jun 2016 this morning (please see that link for all of the presentations made).

I post just two of those presentations here for your review. First, the finances of the ABIM and ABIM Foundation that prompted the creation of Maintenance of Certification, as told by certified public accountant, Charles P. Kroll (27 min) (Slides here):

Next, my presentation on how Maintenance of Certification has affected practicing US physicians and their patients (22 min) (slides here):

Spend some time to review these videos and and inform yourself when you get a chance. Then work with your state medical societies and hospitals to end this onerous and corrupt physician program.

May 9, 2016Folks, let me add my story to this. I am a relatively accomplished community hospital interventional radiologist who has voluntarily recertified in my specialty in 1995 and 2005. I’ve never been sued. I have never had a disciplinary action at the hospital or state level, and I have a pristine NPDB record. I’m US born, educated, trained, and boarded. I’ve been successfully licensed without any challenges or suspensions or issues in 10 states and 2 countries. It became obvious to me as I am in my 27th year of practice in a small somewhat backward hospital that I was never going to do much of what my IR MOC was going to examine me on, nor had I done some of the newer more challenging procedures (Y90, BRTO, etc). Not that I am inexperienced; I have 14000 cases including some fairly extensive vascular experience and aggressive stuff – trigeminal nerve balloon compression, complex spine work, etc. Pre-emptively I applied for and got NBPAS certification, and wrote nasty letters to my board asking how they could justify putting my reputation and career at risk by potentially failing me in my chosen demonstrated specialty after being boarded 3x over 27 years. Needless to say, I got a bunch of platitudes and “we’re working on it”. I was due to take MOC exam, which I had not registered for during the first 6 years of this ten year cycle, but the Board badgers you to do so and finally I relented. I completed all the requirements except the exam, which I was scheduled to take in November but I felt unprepared. I rescheduled and took it in March, 2016, and felt fairly prepared after 3 months of fairly intensive preparation. The exam as it turns out was ridiculously easy. Of 220+ questions I left only 20 blank and I know I got most of the ones I answered correct. Then, 6 weeks later, I found I failed. I’m a big boy; I’ve weathered 1 family tragedy and a near miss with another, but I love my chosen specialty and failing it is absolutely devastating. How do I explain this to my colleagues? My children? Licensing boards? Patients? Certification organizations? Malpractice insurers? Plaintiff’s attorneys? Can you imagine having to be deposed after passing yourself off as a competent conscientious sub specialist for 3 decades and having to tell an attorney you’ve failed your F—ing MOC board exam? The professional humiliation is BEYOND description. And I am not soothed by the fact that I can spend another $1000 and take the exam “as often as I want.” So I cannot think of a more important incentive than to get NBPAS accepted as an alternative and ABMS emasculated.I have proposed to my Board an alternative MOC which would provide maintenance of certification on a point system, with points being given for years in practice, # of states licensed, lack of disciplinary actions, lack of npdb entries and malpractice cases (points both for lack of settlements, lack of cases, being summarily dismissed, etc), PQRS if you insist, and anything else including the exam. That way, in theory, a newbie may elect to take the exam; someone like me with a pristine record of 30 years would garner enough points to be certified without needing the exam. Someone with 15 malpractice cases, a couple of suspensions for substance abuse, on probation from the state, with only one state license, a couple of entries on his/her NPDB query would have a tough time even if they pass the exam….but the proposal rewards you for having a clean record the longer you practice. Going through state licensure is a torture test these days, and every license you get should be a hurdle that counts towards your recertification. likewise, an isolated suit or NPDB entry wouldn’t decrease your point totals to a material level especially when you factor in length of practice, and so forth. Some practitioners might have to take the exam, some might roll the dice to take it knowing their points are borderline, and others wouldn’t need to take it at all if they had enough points. Here’s hoping. meantime, support the NBPAS, badger your hospitals, and write nasty letters to your Boards.

AMA is the parent organization of the ABIM along with the ACP. State delegates of the AMA voted recently to end mandatory MOC immediately. The AMA delegates listened, reflected on it, understood the urgency to end MOC and acted.

They voted courageously and wisely; their vote should count and be acted on. Physicians have overwhelmingly been asking for an end to the MOC recertification mandates and an end to employment related requirements.

MOC is a broken program comprised of complex and egregiously conflicted businesses of the ABMS and its associates. They exist only to fulfill their executives' need for excessively luxurious lifestyles and addictive political habits. We have observed and noted avaricious self-inurement and political appetites to match their excesses and wanton greed.

It is a bankrupt lifestyle and the sources for their financial fixes are running out. So too are the physicians who were hoodwinked for so many years with the façade.

But the AMA delegates have spoken voting to end all mandatory MOC immediately. The people have spoken to end it. The physicians have spoken saying "enough is enough." The end of MOC is the collective democratic will of everyone.

So what's the holdup?

Only the few elites on top living in the 'ivory tower league' with tremendously limited vision. They have conflicted interest in continuing MOC's unproven burdensome business model because it is a lucrative practice and their is a leak in the ABIM's finances.

Why are they all such MOCaholics? The explanation is money and painful addiction to inflicting financial and political harm to themselves and society. That is what the ABIM executives and board appear to be doing. It is what the finances say. It is what the burdensome effect of MOC tells us with an overwhelming show of real-world hands and voices.

But the top 0.05% on top consider it all justified as far as they are concerned. It is the elite way after all of making money easily doing little. MOC is their source of income and the means to accessing the political control which ultimately serves their cronies and the corporate special interests.

The financial and political corruption dials read red. The dangers MOC creates for the healthcare system are sending off shrill alarms or warning and signals of overload for years. The dire consequences of continuing this corrupt and self-serving program called MOC are apparent. Those who do not act to end MOC immediately must unfortunately be forced to leave.

It becomes clear who they are and what organizations hinder our obligations to serve a higher good--the service to the patient--which does and should come first and foremost in our practice. We must safeguard the patient from the dictates of the ABMS. Not forgetting to put the oxygen mask over our own mouths and noses first.

There is no substantive care or understanding of how to deliver care without physicians.

Sorry to harass you on this. I have read the Rebel MD account and your account. I am still confused as to what transpired. I realize u don't work for the AMA. However, is there any way that you can, in very prosaic prose tell us plainly:

1. What was final result in terms of resolutions?2. What was final result re: 10 year exam resolutions?3. What was final result re: MOC?4. After all these resolutions, what do we expect next?

The AMA has declared gun violence a public health crisis.http://www.npr.org/2016/06/16/482279674/ama-declares-gun-violence-a-public-health-crisis

AMA delegate meeting in Chicago

Did I hear you right Dr. Fisher? In the AMA delegate meeting you mentioned a felon with a gun violation was working for the ABIM and was involved in the raid on Dr. Arora's house and investigating physicians?

Did the ABMS or AMA respond to this frightening bit of news from you with an announcement of any kind. Are they going to follow up officially and investigate how a criminal with such a record was placed in such a high position of authority and responsibility at the ABIM and ABMS? Did the AMA ask congress to fund studies of how such criminals could be used by various organizations or state actors to further political causes and special interests?

I would like to have a statement from Dr. Richard Baron and Dr. Lois Nora that the personnel at the ABIM and ABMS are safe from any possible gun violence. I would like a similar statement guaranteeing that physicians who have been harmed by Benjamin Mannes, (ABIM director of investigations) in the past are safe from future physical harm, intimidation and harassment.

I would like to have a statement also from Dr. Baron and Lois Nora guaranteeing that the ABIM and ABMS did not violate any civil liberties of physicians involved in taking Dr. Arora's board review courses. And that no one is presently being violated in such a manner, nor will there be any more victims in the future. I would like a statement that diplomates and candidates' privacy are not being violated. I would like to have that statement certified.

Is this not reasonable, Dr. Fisher? I believe this is prudent. I cannot believe that the insurers of ABIM would not be informed of such a liability and danger to immediate staff and the physician community. Out of 49 dead in the Orlando mass shooting spree 23 Puerto Rican were killed. What do we know of the man who did it.What did we know of Mr. Mannes before a few days ago. What do the employees know who work for the ABIM.

The state of Pennsylvania has gun laws. Does anyone know what they are at the ABIM. Has Mannes had a thorough background check to be in the positions where he holds the livelihood and welfare of 200,000 physicians in his hands.

Can the AMA start its gun control study with its own child the ABIM? We are more than concerned and would like to see a public announcement of how the ABIM, ABMS, AMA and ACP are dealing with these revelations.

Delegates vote to end mandatory MOC immediately and the AMA gives special mention to this at the bottom of its announcements page. Nothing changes substantially.http://www.ama-assn.org/ama/ama-wire/post/ehrs-moc-physicians-tackle-practice-issues-new-policy

"Improving MOC and OCC

A new report from the AMA Council on Medical Education examines the current state of maintenance of certification (MOC) and osteopathic continuous certification (OCC), noting both the physician concerns around such elements as cost effectiveness and relevance to practice and the professional imperative to ensure patients are receiving high-quality care.

The report notes that the council will continue to work with the relevant associations and member boards to identify and suggest improvements to the MOC and OCC programs. Additionally, the council “is committed to ensuring that MOC and OCC support physicians’ ongoing learning and practice improvement.”

“The AMA will continue to advocate for a certification process that is evidence based and relevant to clinical practice as well as cost effective and inclusive to reduce duplication of work,” the report said.

Delegates adopted policy to further these efforts, including:• Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification• Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways• Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practices"

"The MOC principles will now include:• MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.• The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice.• MOC should be used as a tool for continuous improvement.• The MOC program should not be a mandated requirement for licensure, credentialing, payment, network participation or employment.• Actively practicing physicians should be well-represented on specialty boards developing MOC.• MOC activities and measurement should be relevant to clinical practice.• The MOC process should not be cost-prohibitive or present barriers to patient care."

"Consumers, patients, hospitals and other users of the Board Certification credential expect board certified physicians to be up-to-date with the knowledge, judgment and skills of their specialty—both at the point of initial certification and along the physician’s career path – and to verify it through an external assessment. The privilege to self-regulate which physicians enjoy demands that we meet that expectation with more than just continuing medical education. - See more at: http://www.abms.org/news-events/response-to-the-american-medical-association-policy-on-secure-recertification-exam/#sthash.Je3ovB7v.dpuf "

As a board certified physician, I would love to hear everyone's opinion on this "self-regulation" that the ABIM continues to bring up. Dr. Wes has touched on this numerous times, but in no way does our current situation represent self-regulation.

I would wholeheartedly prefer that we be regulated by the government compared to the ABIM. At least we could have a small say by voting, lobbying, and contributing to different ideas and public servant campaigns. We are already heavily regulated by the government and the ABIM adds nothing to patient care beyond an initial certification.

It's sad to say, but I'm less scared of the government compared to the the ABIM.

ABMS on 'legal paper' is a not-for-profit evaluatory organization with voluntary participation. Yet in the real world it is a for-profit regulatory non-governmental agency demanding mandatory participation; and the ABMS and its partners lobby for even more financial boons and greater regulatory control.

But the actual truth is something else altogether. If the AMA parent delegates, and distinguished PA MOC panel, ditched the expensive Hyatt Hotel and met for free at the ABMS offices of (Dr.) Lois Nora, they would have seen behind the thin curtain of Crystal City and actually met the 'king'.

Financially and politically speaking, Dr. Nora's ABMS is little more than a rebranded dirty little burger franchise with high expectations and flim-flam ACGME mentality.

The organization has unsafe parking, an opaque revolving door, gun control policies that could not pass federal muster, and executives cooking up their greasy innovative burgers at home for an outrageous fee.

None of those fat ugly burger franchises could get their executives or their crooked filthy joints to pass an audit or health inspection--not even the 'burger king'.

That's why they had to meet at the Hyatt? "Geez, how our kids live these days!"

"Ballard Spahr is hosting a “Government Relations Roadshow” featuring two former U.S. governors—Pennsylvania's Edward G. Rendell and Arizona's Janice K. Brewer—and a group of political and legal experts who will discuss campaign finance disclosure and “dark money,” the coming presidential race, and the evolving laws that govern political activity."

Specialty Diplomas and Certifications. Earning/Receiving Them From The Same Source--The Residency and Fellowship Program.

"ABMS responds to AMA!" The last breaths of a dying three-headed monster joined at their upper spine. Folks said the ACP, AMA, ABMS were too big to fail.

I hope the AMA council and ABMS execs purchased AMA insurance policies.

What about ABMS Solutions? All those valuable certifications? The cash flow? You'll be able to buy the original software at the Salvation Army soon. And the framed board certifications recovered from a dumpster for 5 cents each. Buy as many as you like.

The hypocrisy continues at the ABMS. Lois Nora invokes the "privilege to self-regulate"? Shame on you Lois. The only folks who have abused any privilege are the ABMS and ABIM who are living high on the hog in their offices and leading their parasitic lives off the clinicians. It is abundantly clear whatever trust that existed between the regulators and those who are regulated have evaporated permanently.

Cayman Island non-public investments? Offshore investment schemes? On top of the most expensive condo in Philadelphia history and a Mercedes limo service to the Four Seasons?

Let's face facts. It's over. No one trusts the ABMS or the ABIM. Nora, Baron et al have utterly and completely failed. And by manufacturing a pseudo-Bogeyman as their justification for the existence of MOC, we see yet another pathetic attempt at self-preservation. It's wholly disingenuous.

Sign the petition demanding reformation. Call the Iowa Attorney General and demand the Iowa AG liquidate the ABIM.Replace the leadership.If Baron and Nora are claiming that MOC is a national imperative, then let the American Taxpayer foot the bill. The whole 9 yards.

And then watch as the limos, the Four Seasons, the bloated salaries, the spousal travel benefits all evaporate in a nanosecond.Watch as Rich and Lois have to apply for a new job taking call, rounding on weekends, and running codes on Holidays just like the rest of us.

Great presentation by all of you, Wes! Great response from the delegates. And very welcome for all of us. But sobering modifications/line item veto from the AMA power council are quite disturbing. Autocratic cleptocracy in action guarding the money flow from ABMS' soylent green MOC factories.

Yet--a clear message from the Pennsylvania Medical Society, a vote of no-confidence in the ABIM. That is right on. Let's hope the law firm the PA MED Society hired investigates the ABIM soon to get at facts before Lynn Landon and others abscond with the documents or just outright destroys them.

Maybe these PA MED SOC attorneys can get the Arora Settlement from Dr. Arora directly as the Newark magistrate has chosen to respect the seal on it. I believe he has no problem himself with sharing the truth, but Arora's attorney, whose offices are a couple minutes walk from Ballard Spahr's Hara Jacobs in Philly may object, because it may show how Jacobs and his lawyer may have colluded to swindle Dr. Arora out of his civil liberties and livelihood. He could have modified his course by hiring former question writers like the USMLE test reviews and other certification review courses apparently do.

The magistrate in Newark in Rushford's case has no clue about copyright or MOC. She will catch on quickly. Smart lady. His lawyers need to walk her down the alley behind ABIM gestapo headquarters and give her a real picture of the ABMS. financial/political neighborhood and lay of the land.

What shall we do with a reckless drunken sailor? Put him in the scuppers with a hose pipe on him?

The flagship of the ABIM is scuttled, lying belly-up in the sand. The ship is bleeding out cash through the gills. We need to board her, stop the financial leaks, and make a few repairs to the bylaws. And we must return the ABIM Foundation, Cayman, Hedge fund cash to where it belongs--in the ships hold.

Then, if ABIM can be made seaworthy, put her out to sea at a reasonable cost with an all volunteer captain, first mate, cook and crew. But they must all be honest and reliable, in touch with current medical science and healthcare reality.

But not before MARCHING MOC AND THE DRUNKEN RECKLESS SAILOR DOWN THE PLANK!

The next phase in "operation restore sanity to the ABMS" is to SHOW OUR ANTI MOC COLORS and sail up along each ship and arm ourselves with a superior intelligent argument and show how happy our sailors are without MOC. No more constant beatings and rusty old leg irons. No more heads

Why doesn't Captain Baron say something. He's locked himself in the Captain's quarters and he's not talking. Is he gagged? Or has one of his pirate cronies cut out his tongue?

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.